Is it Time for Physician Assistant (PA)/Nurse Practitioner (NP) Hospital Medicine Residency Training?
American Journal of Hospital Medicine
The roles of non-physician providers, such as physician assistants (PA) and nurse practitioners (NP), are constantly evolving in the United States healthcare system. They are a vital part of many inpatient multi-disciplinary teams and their role is even more challenging on the busy hospitalist services. The demand for hospitalists is constantly increasing and the current supply of physicians has been unable to keep up with the increase in demand. Residents' now restricted duty hours and
... y hours and regulations have further widened the gap. With a record number of patients seeking healthcare (1), a reliance on mid-level providers has increased tremendously in the last few years. Non-physician providers are required to provide a high level of clinical care to complicated hospitalized patients, side-by-side with their physician colleagues. Non-physician providers are sometimes seen as the solution to all sorts of problems for which they have not been prepared during their education. Most PA programs are two to three years long and require the same pre-requisite courses as medical schools do. PAs complete more than 2,000 hours of clinical rotations and must pass the Physician Assistant National Certifying Exam (PANCE), which is administered by the National Commission of Certification of Physician Assistants, before they can practice. NP candidates usually gain clinical experience working as a registered nurse (RN) for two or more years prior to their entry in the NP program. The NP programs vary in length from one to two academic years. Success of non-physician providers is much more established in the internal medicine ambulatory setting. Meyers et al. describe success of mid-level provider-based model in chest pain units, where the participation of non-physician providers on the team resulted in not only financial benefit but also increased resident and physician satisfaction (2). Similar experiences were documented in other specialties including general surgery, trauma, pediatric neurosurgery, mental health, emergency medicine and primary care (3-7). PA and NP schools provide a good clinical base, but they lack many aspects regarding teaching clinicians how to be effective and efficient hospitalists. Currently a hospitalist is not only required to be a champion of inpatient care but also as a leader in patient safety and clinical quality initiatives. Many hospitalist leaders are skeptical about the adequacy of education and training of non-physicians to work as hospitalists. Parekh and Roy stressed the limited data availability of success of non-physician providers as hospitalists (8). Sehgal et al. published in Journal of Hospital Medicine regarding hospitalist models of different academic medical centers that used non-physician providers as part of their staffing model. The